Document Detail

If a well-stabilized epileptic patient has a subtherapeutic antiepileptic drug level, should the dose be increased? A randomized prospective study.
MedLine Citation:
PMID:  3280304     Owner:  NLM     Status:  MEDLINE    
In an attempt to determine whether the dose of an antiepileptic drug should be increased in epileptic patients who were seizure-free and had subtherapeutic serum levels, 79 patients with idiopathic generalized tonic-clonic seizures treated with monotherapy [phenytoin (PHT) or phenobarbital (PB)] and with a subtherapeutic serum level were prospectively studied. Their last seizure was at least 3 months prior to entry, and no patient had any clinical evidence of toxicity. They were randomized to study arm A (keeping the level in the subtherapeutic range) or study arm B (increasing the dose until the level reached and stayed at the therapeutic range). Over a mean follow-up period of 24 months, there was no significant difference between the two study arms in the occurrence of seizures, but arm B patients had an increased incidence of neurotoxic side effects from the dose increment. These results confirm the clinical impression that it is unnecessary to increase the dose of the antiepileptic drug despite a subtherapeutic serum concentration in a relatively well-stabilized patient, thus minimizing the frequency of dose adjustment and the need for expensive therapeutic drug monitoring.
E Woo; Y M Chan; Y L Yu; Y W Chan; C Y Huang
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Epilepsia     Volume:  29     ISSN:  0013-9580     ISO Abbreviation:  Epilepsia     Publication Date:    1988 Mar-Apr
Date Detail:
Created Date:  1988-04-28     Completed Date:  1988-04-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  2983306R     Medline TA:  Epilepsia     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  129-39     Citation Subset:  IM    
Department of Medicine, University of Hong Kong, Queen Mary Hospital.
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MeSH Terms
Clinical Trials as Topic
Dose-Response Relationship, Drug
Drug Administration Schedule
Epilepsy / blood,  drug therapy*
Phenobarbital / administration & dosage,  blood*
Phenytoin / administration & dosage,  blood*
Prospective Studies
Random Allocation
Reg. No./Substance:
50-06-6/Phenobarbital; 57-41-0/Phenytoin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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